1. Behavioral Health Integration and Beyond
The Pathway to Fully Integrated Managed Care
Presentation for The 11th Annual Provider Conference
Joe Valentine,
North Sound Behavioral Health Organization
“Empowering Individuals and Families to Improve Their Health and Well-Being”

2. QUESTIONS TO BE ADDRESSED
What has changed in the public funding of behavioral health services
What is a Behavioral Health Organization?
What is the Behavioral Health System of Care?
What is the future for the North Sound Behavioral Health System of Care?
What is the pathway to fully integrated managed care?

3. WHAT WOULD SUCCESSFUL INTEGRATION OF BEHAVIORAL HEALTH AND PRIMARY CARE LOOK LIKE FOR OUR CUSTOMERS? What would it look like for Joe?
Joe is a 50 year old homeless man, chronic alcoholic, diabetes and frequent visitor to Emergency Departments

4. What Has Changed in the Public Funding of Behavioral Health Services?
1989 – Legislature allows counties to form “Regional Support Networks” for mental health services
1991 – formation of the North Sound Regional Support Network
1994 – Establishment of a formal “Interlocal Agreement”
2006 – transition to managed care for RSNs
2014 – SB 6312 directs the integration of mental health and chemical dependency services
2016 – North Sound Behavioral Health Organization LLC

5. Behavioral Health Organizations
SB 6312 integrated financing for SUD services into the former RSN- mental health managed care system.
The state provides “capitated” payments for all medically necessary MH and SUD services for Medicaid enrollees.
These rates are based on an actuary process factoring in # Medicaid enrollees, projected utilization, and cost of services
BHOs must provide a full “network” of integrated mental health and substance use disorder services

6. The North Sound BHO MENTAL HEALTH SERVICES
EXPANDED – SUD AND INTEGRATED SERVICES
Crisis Services
Integrated Crisis Services
Involuntary Commitment
CD “Involuntary Commitment”
Evaluation & Treatment Facilities
Acute Detox - Everett
Triage Centers – mental health
Whatcom and Skagit Triage: sub-acute detox
Psychiatric Hospitalization
Psychiatric Residential Treatment
SUD Residential Treatment

7. The North Sound BHO MENTAL HEALTH SERVICES
EXPANDED SUD AND INTEGRATED SERVICES
Outpatient Services
SUD Individual and Group OP
Intensive Outpatient Services
SUD Intensive OP
Medication Management
Medication Assisted Treatment
PACT Teams
Children’s Wrap-Around - WISe
SUD services for Pregnant and Parenting Women
Jail Transition
Unfunded

8. The Behavioral Health System of Care
The BHO is only one part of the “Behavioral Health System of Care”.
Behavioral Health Agencies – Outpatient and Residential
County Human Service and Public Health Departments
Crisis Line
DMHPs and Mobile Crisis Teams
Triage Facilities
Detox

9. The Behavioral Health System of Care
The BHO is only one part of the “Behavioral Health System of Care”.
Hospitals
Primary Care Clinics – Apple Health Mental Health services
Law Enforcement – “911”
Courts - Therapeutic and ITA
Tribal Behavioral Health Programs
School based behavioral health services
Community prevention programs

12. The Future for the North Sound Behavioral Health System of Care
Continue to expand access to mental health and SUD services
Add new SUD providers to serve “niche” populations
Expand Medication Assisted Treatment
Improve access to services in geographically challenged areas
Integrate screening and treatment of mental health and SUD services

13. The Future for the North Sound Behavioral Health System of Care
Expand training for the workforce
Improve electronic health record systems and health information exchange
Support expansion of “collaborative care” and care coordination between behavioral health agencies and primary care

14. The Behavioral Health Facilities and “Recovery System of Care” Vision
Develop new, smaller, community based mental health and SUD treatment facilities in the North Sound- coming on line in 2017:
Lynwood- Evergreen Recovery
16 Bed Acute Detox
Mount Vernon Evergreen Recovery
24 Bed SUD Intensive Inpatient
Bellingham- Lake Whatcom Residential and Treatment Center
16 Bed SUD Intensive Inpatient

15. The Behavioral Health Facilities and “Recovery System of Care” Vision
Develop new, smaller, community based mental health and SUD treatment facilities in the North Sound- for FY 17-19:
Skagit “Stabilization Campus”
North Sound E&T replacement for Sedro Wooley
Acute Detox
Possible future re-location of Skagit Triage
Everett Denny Youth Center
(2) 16 Bed SUD and/or Co-Occuring Treatment facilities
Bellingham
16 Bed Mental Health Triage
16 Bed Detox
West Skagit County
“Tri-County” Triage/Sub-acute
TBD
16 Bed “Long Term Care” SUD replacement beds for Pioneer North

16. The Behavioral Health Facilities and “Recovery System of Care” Vision
Develop new, smaller, community based mental health and SUD treatment facilities in the North Sound- for FY 19-21:
All Counties
Recovery Houses
Skagit
“Recovery Campus” : recovery and long term housing, health, employment, and social services
TBD
16 bed SUD and “Co-Occurring” Treatment Facilities

17. The Behavioral Health Facilities and “Recovery System of Care” Vision
RECOVERY SUPPORTS FOR JOE:
Ongoing engagement in treatment – and “check-ins”
“Recovery Coach”
Access to Housing
Access to employment and other social services
Access to Health Care!

18. The Pathway to “Fully Integrated Managed Care”
SB 6312 also directed that by January, 2020, the “community behavioral health program must be fully integrated in a managed care health system, that provides mental health services, chemical dependency services, and medical care services to Medicaid clients” A model for financial integration of Medicaid services with Apple Health “Managed Care Organizations” is being piloted in the Southwest and North Central Regions.

19. The Pathway to “Fully Integrated Managed Care”
Counties have requested of the Governor’s Office and the Legislature a role in the decision making for the design and implementation of the model in each region within state established parameters.
This request would establish “Interlocal Leadership Structures” within each region jointly administered by “County Authorities”, the state Health Care Authority and the Apple Health MCOs

20. The Pathway to “Fully Integrated Managed Care”
The Interlocal Leadership Structure must also fully engage:
Primary Care Providers
Behavioral Health Providers
Tribes
Other Stakeholders, including the “Accountable Community of Health”

21. The Pathway to “Fully Integrated Managed Care”
The Interlocal Leadership Structure is responsible to design and implement a fully integrated managed care model for each region that:
Assures clients are at the center of care delivery and:
Supports integrated delivery of physical and behavioral health care at the provider level

22. The Pathway to “Fully Integrated Managed Care”
Key Tasks for the Interlocal Leadership Structure:
Align contracting and administrative functions to minimize the administrative burden for providers
Monitor implementation including development of an “early warning system”
Develop regional coordination processes for capital infrastructure requests and local capacity building
Develop and build on data measures to maintain accountability for delivery system performance

23. The Pathway to “Fully Integrated Managed Care”
Key Tasks for the Interlocal Leadership Structure: Discuss whether managed health care systems awarded the contract by the authority for a region should sub-contract with county-based administrative service organization or other local organizations, which may include and determine, in partnership with that organization, which value-add services will best support a “bi- directional” system of care

24. The Pathway to Fully Integrated Managed Care and the Accountable Communities of Health
The Accountable Communities of Health [ACHs] are charged with the responsibility to design and implement projects to support the State’s Health Care Transformation Goals
The ACHs will be receiving “Medicaid Waiver” funds to support this work
Includes development of a strategy to support “bi-directional” integration of care between primary care clinics and behavioral health agencies
ACHs are also to suggest a model for moving towards fully integrated managed care

25. The Pathway to Fully Integrated Managed Care and the Accountable Communities of Health
In the North Sound, the BHO will work with the NSACH to engage providers and other stakeholders in the design of what the ideal system for the North Sound should look like.
The vision for an ideal system should improve access to behavioral and physical health care for persons with serious mental illness and addictions.

26. The Pathway to Fully Integrated Managed Care and the Accountable Communities of Health
The ideal system for fully integrated managed care should improve access to behavioral and physical health care for Joe!

27. Questions?
For more information: Joe Valentine, Executive Director North Sound Behavioral Health Organization Empowering Individuals and Families To Improve Their Health and Well-Being